Should there not be a follow up study to find out if there is a difference in ischemic stroke between the two groups? After all that is what we really want to prevent.
One tiny quibble with word choice: we often say the patient “required” a treatment or intervention when we mean that the patient “was provided” with a treatment.
The implication is that, had we not provided a treatment, an undesirable outcome would have occurred. In the AF study patients who “required” cardioversion after 48 hrs, we don’t know whether they would have spontaneously converted subsequently. They were provided with cardioversion because that is what the study protocol prescribed. Let’s try to distinguish “Patient needed the treatment” from “Patient was given the treatment”.
As this piece so well describes, often our decision to provide a patient with a treatment arises from factors in us, not the patient.
I thought this article may interest you! https://thealienthatategod.substack.com/p/the-soliton-vascular-coupling-mapping
I’ve always considered “doing nothing TID” to be as active and overt a clinical decision as doing something.
This is a good reminder that we should have evidence of benefit before embarking on doing anything other than nothing.
Thank you for an objective look at this issue
Should there not be a follow up study to find out if there is a difference in ischemic stroke between the two groups? After all that is what we really want to prevent.
Now we just have to change the Delay in diagnosis, Delay in treatment, Failure to consult quicksand.
…were frequently in sinus rhythm at postop office visit- nowadays, most “require” cardioversion before discharge.
In decades past, I observed that post-CT surgery patients with post-op AF who were discharged on rate-control and anticoagulant
An excellent piece with a well-taken message.
One tiny quibble with word choice: we often say the patient “required” a treatment or intervention when we mean that the patient “was provided” with a treatment.
The implication is that, had we not provided a treatment, an undesirable outcome would have occurred. In the AF study patients who “required” cardioversion after 48 hrs, we don’t know whether they would have spontaneously converted subsequently. They were provided with cardioversion because that is what the study protocol prescribed. Let’s try to distinguish “Patient needed the treatment” from “Patient was given the treatment”.
As this piece so well describes, often our decision to provide a patient with a treatment arises from factors in us, not the patient.
A testimony to the often ignored power of the human body to “heal thyself “.
Have you ever read anything by Dr. Tom Cowan on heart attacks? Might be relevant as well.
“Give peace a chance” or perhaps “Tincture of time”
Very well written and concluded thank you!